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Palliative care will lose out if euthanasia legalised, says Monash psychiatry head

By Natasha Marsh November 10, 20170

PHOTO: Hush Naidoo

Up to $15 million of desperately-needed funds for thousands of palliative care patients will be diverted to about 150 people who want assisted suicide each year if the Victorian euthanasia bill becomes law.

Professor David Kissane, Head of Psychiatry at Monash University, warned that the two euthanasia Bills facing VIC and, shortly, NSW, redirect much-needed palliative care funds to a tiny percentage of people.

“[Euthanasia’s supporters] say that the Bill is going to look after about 150 people who want that autonomous choice, but there will be thousands of people who could have accessed Palliative Care if that same money was directed to Palliative Care services,” he said.

If passed, the Victorian Government will spend between $10-15 million implementing its assisted dying Bill. The money would include training, establishing a Voluntary Assisted Dying Review Board, and forming an academic department at one of Melbourne’s universities to research the best possible “lethal dose” to make available to patients.

Last year, 39,450 people died in Victoria. If the proposed Bill in Victoria is passed, it is estimated about 150 people will be eligible for, and wish to, access assisted dying – approximately 0.38 per cent of the predicted deaths across the Victorian State. Similar numbers are recorded in NSW.

“The problem with the legislation is that it is spending millions without addressing that money to Palliative Care,” Prof Kissane told The Catholic Weekly. The 2015 Victorian Auditor-General’s report found deep gaps in equal provision of medical care in Victoria. Most worrying was the lack of access of palliative care to rural Victorians – especially concerning considering that the highest age-specific suicide rate in Victoria is males aged 85 years and over, many of which live in rural areas.

In August a damning report on the state of Palliative Care in NSW was released by NSW Auditor-General, Margaret Crawford. Its opening sentence read: “NSW Health’s approach to planning and evaluating palliative care is not effectively coordinated. There is no overall policy framework for palliative and end-of-life care, nor is there comprehensive monitoring and reporting on services and outcomes.”

In its submission to the NSW Government on the Voluntary Assisted Dying Bill 2017, Palliative Care New South Wales pulled no punches on the state of Palliative Care in NSW.

“Access to Palliative Care is neither universal nor equitable. Some two out of every five people in NSW die in residential aged care facilities but many residential aged care services lack access to Registered Nurses and GPs, much less to specialist trained Palliative Care practitioners. In community surveys many people don’t know what Palliative Care is,” they said. Palliative Care NSW said that improvements to palliative care was “essential before a more advanced debate about VAD can be considered in the best interests of the people of NSW.”

Despite this, and despite the submissions from hundreds of medical bodies and groups calling for greater resources to Palliative Care, euthanasia advocates in NSW and Victoria keep offering euthanasia or assisted suicide as the answer to providing compassionate end of life care, and suggest taking from the Palliative Care budget to provide it.

Prof Kissane is also concerned about the likelihood of patients suffering from subtle mental illnesses – like depression or demoralisation – gaining access to lethal doses.

Studies, some conducted by his own department, show that currently 15 per cent of people in Palliative Care suffer depression, with a further 15 per cent suffering from demoralisation.

“Demoralisation is where a person has lowered morale, hopelessness, pointlessness and a loss of purpose in their life. It is a state of looking negatively at their future, although they can still experience pleasure or humour in the here and now, while depression is a state where the person loses pleasure in the here and now,” he said.